Decision Focus: Statins to Prevent Stroke
Statins are used to lower cholesterol, but they may also help prevent stroke.

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Decision Focus: Statins to Prevent Stroke

Statins are a standard treatment to lower cholesterol. Study after study has shown that statins cut the risk of heart attack and death by lowering low-density lipoprotein cholesterol (LDL). This is the "bad" cholesterol. But statins can also help prevent stroke.

Is it right for you? Here's what you need to know.

What is a statin?
These drugs lower cholesterol by blocking its formation in the liver. But studies are showing that they have other effects on blood and blood vessels. Most notably, statins reduce inflammation in the blood vessels.

How do statins help reduce the risk of stroke?
The most common type of stroke is ischemic stroke. This happens when blood is blocked from flowing to the brain. Usually this is caused by blood clots. Plaque buildup that narrows arteries is also a factor. Other risk factors are high blood pressure, cigarette smoking, heart disease, diabetes and small strokes known as transient ischemic attacks.

It's not exactly clear how statins reduce the risk of stroke. The drugs seem to help reduce plaque and decrease inflammation. These factors may play a larger role in preventing stroke than lowering LDL cholesterol.

What do the studies show?
Large studies show statins cut the risk of a first stroke in people at risk for cardiovascular disease. Other studies have looked at preventing recurrent strokes. One of these studies found that statins reduced the risk of a second stroke by about half (from 16.3 percent to 7.5 percent). This was independent of the study participants' cholesterol levels and other risk factors for heart disease. In this group, the risk of death was also much lower when taking statins.

Another study tested rosuvastatin in people who had high C-reactive protein levels. This is an indicator of inflammation in the blood vessels. Participants had normal cholesterol levels. In this study, rosuvastatin cut the rate of heart attack and stroke by half after two years. The FDA has since approved rosuvastatin for use when C-reactive protein levels are high if some other conditions are met such as age, and the presence of at least one other risk factor for heart disease.

These studies suggest statins do protect against strokes, regardless of a patient's cholesterol level. Questions still remain, though. How exactly do statins work against stroke? Are there side effects doctors don't know about yet? What are the effects of lowering normal cholesterol levels?

Doctors are also studying whether they should use statins in combination with other drugs for better results. One small study looked at statins, ACE inhibitors and antiplatelet drugs. Strokes were less severe and hospital stays were shorter when all three were used. But more research is needed.

Note: These study results apply to ischemic stroke. Statins do not prevent hemorrhagic strokes. These occur when a blood vessel bursts.

Bottom line
You may be a good candidate for statins if you:

  • Have high cholesterol and other risks for cardiovascular disease
  • Have already had a heart attack, ischemic stroke or TIA (transient ischemic attack)
  • Have a high level of C-reactive protein, are at least 50 years old and have at least one major risk factor for heart disease (this applies to rosuvastatin)

Talk with your doctor about your risk factors for stroke and heart attack. Use this information as a starting point.

Emily A. King contributed to this report.


By Geri K. Metzger, Contributing Writer
Created on 04/15/2004
Updated on 01/28/2013
  • Tong D. Statins and stroke. Neurology. 2009;72;e112.
  • National Institute of Neurological Disorders and Stroke. Stroke: Challenges, progress and promise.
  • Agency for Healthcare Research and Quality. Treating high cholesterol: A guide for adults.
Copyright © OptumHealth.
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